Category: Public Health Law Research

Anti-Bullying Legislation: Safer Schools through Legal Intervention

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By Marizen Ramirez, PhD, MPH

Bullying is the most frequent form of peer victimization in schools, impacting about 10-25% of all children across the United States. The effects of bullying on children have been well-documented, from psychological and physical harm, poor academic performance, alcohol and drug use, and violent behaviors. In its most extreme form, relentless bullying has even driven some young people to suicide. The 2011 documentary, Bully, depicts the tragic stories of Tyler Long and Ty Smalley, who, because of the chronic ridicule and physical harassment they faced, took their own lives.

Stories like Tyler’s and Ty’s have pushed bullying into the public eye, making it a public health issue of national importance. Across the country, efforts abound to prevent bullying and to help provide safe, welcoming environments for our children when they are at school.

Bullying prevention is being approached in a few different ways. National campaigns like Stop Bullying Now! work to increase awareness about bullying and strategies for prevention. Since its inception, the Stop Bullying Now! campaign has provided resources, including an online toolkit of educational materials, to schools and youth clubs throughout the country. Schools have also implemented a variety of anti-bullying curricula to improve school climate and prevent bullying behaviors in schools. Among these programs are the famous Olweus program developed in Norway in the 1980s, and Positive Behavior Interventions and Supports (PBIS), a program targeting the reduction in school-wide behavioral problems including bullying. The effectiveness of curricula, such as Olweus and PBIS, in reducing rates of bullying in American schools has yet to proven, however.

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Public Health Protection under the EPA Lead and Copper Rule

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Dr. Yanna Lambrinidou and Dr. Marc Edwards

It is generally safe to assume that, when it comes to contaminants in drinking water, consumers are protected by regulation and proactive water utilities.

One noteworthy exception is the federal law promulgated to protect the public from lead at the tap. Known as the Lead and Copper Rule (LCR), this law splits responsibility for minimizing exposures between utilities and consumers. The rationale for this “shared responsibility” approach is that in the majority of cases lead leaches into water from lead service lines (LSLs) (i.e., the pipes that connect water mains to individual homes) and lead-bearing home plumbing materials (e.g., lead solder, leaded brass). These sources of lead are often partly or fully inside the home – LSLs and lead solder were used routinely until 1986, and the use of leaded brass will continue to be legal until 2014. Moreover, differences in plumbing and water usage (e.g., volume, flow), make lead leaching in every house unique. Under the LCR, utilities are required to monitor a small number of homes considered “high risk” for lead in water, but consumers are responsible for having their own water tested and for adopting health-protective water-use practices that minimize the risk of exposure.

When utilities detect elevated lead levels in more than 10% of the homes they sample, they must tell consumers how to avoid exposure by, for example, flushing stagnant water before use and avoiding consumption of hot tap water (especially for reconstituting infant formula). They must also implement a LSL replacement program.  Although full LSL replacement is the only way to eliminate the risk from lead pipes, the LCR requires utilities to replace only the portion of a LSL that they own. The consumer-owned portion of the line is left in place, unless homeowners agree to pay for its removal, which can cost several hundred to several thousand dollars.

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Happy Public Health Week: “We’re Good Enough, We’re Smart Enough, and Doggone It, People Like Us”

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By Scott Burris

We may be living in a golden age of group-think. A weekly reminder is poor Paul Krugman railing against the apparently universal belief in America and Europe that we’ve got to cut budgets right now or disaster will strike. He calls this a Zombie idea, a false claim that has been falsified with plenty of stakes in the heart, silver bullets and blows to the head, but will not stay in the grave.

Closer to home for us in public health is the claim that Americans don’t like government rules regulating their behavior and meddling with their preferences.  Cass Sunstein and Richard Thaler have delivered some solid blows to the idea that paternalism typically messes with solid preferences. As we celebrate Public Health Week, I want to highlight two recent papers that show that Americans, like the children in Mary Poppins, actually like their nannies, who do some pretty great things.

Public Health Law Research has recently posted the manuscript of a paper that Evan Anderson and I have prepared for the Annual Review of Law and Social Science. The paper describes the dramatic rise of law as a tool of public health since the 1960s in five major domains: traffic safety, gun violence, tobacco use, reproductive health and obesity.  These topical stories illustrate both law’s effectiveness and limitations as a public health tool. They also establish its popularity by the most apt of metrics – the willingness of legislators to enact it. The one picture worth a thousand words, below, depicts the rapid adoption of a variety of interventions by state legislatures. (By the way, the five examples also show that public health law research can and does influence the development and refinement of legal interventions over time.)

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Disseminating Where It Matters

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By Scott Burris
Public Health Law Research funded Dr. Caleb Banta-Green to evaluate the implementation and initial effects of a Washington State “Good Samaritan 911” law meant to encourage people witnessing a drug overdose to call for help. The research results are getting out in the usual way, but it was great to see Dr. Banta-Green talking about his findings and what the might mean on the blog of the Office of National Drug Control Policy. Overdose is a huge health issue in the US, but solving it will require the buy in of law enforcement and legislators who defer to law enforcement on drug issues.  It’s great to see research producing the right conversation in the right place.

Times Report Models Worst Practices for Policy Research Reporting

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By Scott Burris

I read the Times daily, and so naturally would like to be able to think it deserves to be regarded as a credible “newspaper of record.”  Today the paper outdid itself to disappoint, in a story by Sam Dolnick headlined “Pennsylvania Study Finds Halfway Houses Don’t Reduce Recidivism.” In the cause of making lemons from lemonade, I am drawing a list of “worst practices” from this little journalistic fender-bender:

Worst Practices Reporting Policy Evaluation Research (Provisional – come on readers, add your own.)

1. Don’t provide a title or author of the study or publication information on the study being described.

The story says only that it was conducted by the PA Department of Corrections and overseen by the state corrections department. There is a link later in the story to what turns out to be the Department’s annual report on recidivism. Not quite a “study” of halfway houses.

2. Don’t clearly describe the study.

The story does describe the study adjectivally – as “groundbreaking.”  It is, first of all, a bit of a stretch to call it a “study” at all. This is not the result of a systematic effort to explore the specific question of whether halfway houses work better than direct release to the street; it certainly was not a peer-reviewed or published study. Rather, the Times story is drawing on one section of an annual report produced by the state on recidivism among all prisoners released through all release mechanisms. The term “study” and the consistent suggestion that the study is important (“groundbreaking” results “so conclusive” that have “startled” leaders and experts) might lull the reader into believing that the “study” was well and deliberately designed to answer the question it supposedly posed – for example, a randomized, controlled and blinded trial of releasing prisoners directly to the street compared to halfway houses. Nope. This report is just a summary of outcome statistics, with a couple of paragraphs reporting in general terms on some statistical analysis meant to control for differences in the prisoners sent to halfway houses compared to those released to the street.

3. Just ignore the obvious problems for causal inference.

The plain and fundamental problem with pumping this study as powerful support for the claim that halfway houses don’t work is that we have no reason to be confident that the prisoners put into halfway houses are, as a group, the same as prisoners released directly to the street. It is elementary that statistical controls for observed differences cannot make up for a non-random, retrospective design that cannot also control for unobserved or unknown differences. Saying that this study “is casting serious doubt on the halfway-house model” is perhaps an attempt at caution, but way too weak a one. This study cannot cast serious doubt on anything, though it certainly points, as the report itself says, to worrisome outcomes in the halfway house system.

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The Ban on Federal Funding of Syringes — continued

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People arguing that our federal government spends “too much” sound more and more like cynics by Oscar Wilde’s famous definition: knowing the price of everything and the value of nothing.

I’m neither for big government nor small government. I’d like government that does important things effectively and efficiently. One very effective and efficient way to spend federal money would be on syringe exchange, probably the single most effective non-medical intervention we’ve ever devised to fight HIV. Unfortunately, the Congress that has endless time and energy to debate symbols has no time or energy to end the ban on paying for syringes with federal funds.

amfAR has put out a very nice short film on this, as part of its renewed effort to convince Congress to end the ban.  It makes a convincing case, with simple stories and basic facts. Pass it on.

Flu Vaccine Mandates for Health Care Workers

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According to officials, the worst of this year’s devastating flu season should be over in most parts of the country. But in early January, the flu had hit 47 of 50 states. According to the CDC, a total of 78 influenza-associated pediatric deaths have been reported. Throughout this terrible flu season, there’s been much talk about vaccination mandates for health care workers.

States have started passing legislation regulating health care worker flu vaccination, and an increasing number of hospitals have started implementing policies in attempt to reach the Healthy People 2020 goal of having 90 percent of health care workers vaccinated. Only two-thirds of health care workers were vaccinated against the flu last year. This can leave patients at risk and hospitals short-staffed because of absenteeism.

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The Law School Reform Panic

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By Scott Burris

I am going to take a slight detour from health law to talk about legal education. This week the Times was all over a story about the need to drastically reform law school right now, and in the classic panic mode, one particular model was being embraced with the same unmixed faith with which a drowning person embraces a life preserver: cutting law school to two years. This was a main suggestion of the poster boy of reform, Brian Tamanaha.  I liked his book as a call to arms and expose. I learned, for example, that I was employed by one of the few schools that did not run up faculty salaries. What I didn’t like is the focus on cost: there’s probably a lot more wrong with law school than the price tag, and, in the absence of  evidence or even a serious theory, I don’t see how shortening law school would solve its problems.

Brian talks a lot about cost and time spent in school, and much of this discussion seems to me to assume that law school is mainly about training people to be lawyers within a fairly traditional conception of what the proper training for a lawyer should be.  He recounts disagreements, repeated many times over a century, between a “trade school” and an “academic” model. In the former, students learn the basic skills of research and writing (and we’d add nowadays things like interviewing and counseling and trial practice), while in the latter there is also some sort of additional training, or an approach to learning, that entails getting a broader understanding of the legal system.

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Reducing Gun Violence in America

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Typically, we would avoid such a shameless plug for our researchers — we’d be a little more subtle. But, we can’t help it this time. This book is the best $10 you’ll spend all year.

A little less than a month ago, Johns Hopkins University convened more than 20 of the world’s leading experts on gun violence and policy to summarize their research and recommend policy changes. This 282-page book features empirical research from the leading experts in the field covering the topics of mental health and gun violence, gun law enforcement, high-risk guns, international case studies of responses to gun violence, the Second Amendment, public opinion on gun policy, and concludes with a summary of the recommendations for reforms to Federal policies.

Chapter 3, “Preventing Gun Violence Involving People with Serious Mental Illness,” features research conducted by Jeffrey Swanson, PhD, and his team of researchers based at Duke University. The research presented was funded by PHLR and the National Science Foundation.

Seriously. Check it out.

Dave Purchase and Naloxone, Life Savers

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By Scott Burris

Start with the sad news of the week. Dave Purchase died, aged 73. Dave was the father of needle exchange in the US, which as far as anyone can say started with Dave and a TV tray in disregard of Oregon’s drug paraphernalia law. Dave was a father figure to a whole generation (or two) of harm reduction advocates and providers. The Times obituary hits the key points in his life story, but not the calm moral force he brought to the movement. He was a man who did the right thing, modestly and steadily, and inspired others to do the same. He saved more lives than most people ever will, and had more friends. We’ll miss him.

On the good news front, Dave would have been happy to spread the word about the latest study on overdose programs using naloxone. Alex Walley and colleagues from Massachusetts reported this week in the British Medical Journal on the effects of the Massachusetts program. Between 2006 and 2009, six community overdose programs were launched to teach potential bystanders about how to recognize and respond to overdose, including with the use of nasal naloxone. Walley’s study reports that the deaths went down in places with the programs compared to places without, and that the reduction was significant in places that had a high level of implementation.

Meanwhile, the removal of legal and financing barriers to overdose programs continues to be a fairly hot item on state legislative agendas. How about every state getting on board? This would be a fine week for a series of “Dave Purchase Life Saver Acts.”